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Previous studies have attempted to forecast the costs of mental health care, using clinical and individual variables; the inclusion of ecological measures could improve the knowledge of predictors of psychiatric service utilisation and costs to support clinical and strategic decision-making.
Using a Psychiatric Case Register (PCR), all patients with an ICD-10 psychiatric diagnosis, who had at least one contact with community-based psychiatric services in the Verona Health District, Northern Italy, were included in the study (N = 4558). For each patient, one year's total cost of care was calculated by merging service contact data with unit cost estimates and clinical and socio-demographic variables were collected. A socio-economic status (SES) index was developed, as a proxy of deprivation, using census data. Multilevel multiple regression models, considering socio-demographic and clinical characteristics of patients as well as socioeconomic local characteristics, were estimated to predict costs.
The mean annual cost for all patients was 2,606.11 Euros; patients with an ongoing episode of care and with psychosis presented higher mean costs. Previous psychiatric history represented the most significant predictor of cost (36.99% R2 increase) and diagnosis was also a significant predictor but explained only 4.96% of cost variance. Psychiatric costs were uniform throughout the Verona Health District and SES characteristics alone contributed towards less than 1% of the cost variance.
For all patients of community-based psychiatric services, a comprehensive model, including both patients' individual characteristics and socioeconomic local status, was able to predict 43% of variance in costs of care.
Most mortality studies of psychiatric patients published to date have been conducted in hospital-based systems of care. This paper describes a study of the causes of death and associated risk factors among psychiatric patients who were followed up over a 20-year period in an area where psychiatric care is entirely provided by community-based psychiatric services.
All subjects in contact with the South Verona Community-based Mental Health Service (CMHS) over a 20-year period with an ICD-10 psychiatric diagnosis were included. Of these 6956 patients, 938 died during the study period. Standardized mortality ratios (SMRs) and Poisson multiple regressions were used to assess the excess of mortality in the sample compared with the general population.
The overall SMR of the psychiatric patients was 1.88. Mortality was significantly high among out-patients [SMR 1.71, 95% confidence interval (CI) 1.6–1.8], and higher still following the first admission (SMR 2.61, 95% CI 2.4–2.9). The SMR for infectious diseases was higher among younger patients and extremely high in patients with diagnoses of drug addiction (216.40, 95% CI 142.5–328.6) and personality disorders (20.87, 95% CI 5.2–83.4).
This study found that psychiatric patients in contact with a CMHS have an almost twofold higher mortality rate than the general population. These findings demonstrate that, since the closure of long-stay psychiatric hospitals, the physical health care of people with mental health problems is often neglected and clearly requires greater attention by health-care policymakers, services and professionals.
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